Common needs but divergent interventions for U.S. homeless and foster care children: results from a systematic review.

Many children living in homeless situations in the U.S. have temporary stays in foster care, and both populations suffer disproportionately higher rates of physical, psychological and social difficulties compared with other children.

Long-term and chronic homelessness in homeless women and women with children.

The Chronic Homelessness initiative has directed millions of federal dollars to services for single "unaccompanied homeless" individuals, specifically excluding women living with their children. Using a data set with a nationally representative sample of homeless adults, we calculated the prevalence rates and profiles of long-term homelessness in homeless women (n = 849). With the exception of the criterion of being a single "unaccompanied individual," many women, including women with children, met the criteria for chronic homelessness including having a disability of mental health or substance abuse problems.

What research tells us about the intersecting streams of homelessness and foster care.

This paper reviews mounting evidence linking foster care and homelessness and considers new approaches for intervention. Although there is no causal evidence that family homelessness leads to foster care or vice versa, the association no longer originates solely from samples of homeless people, but also from samples of people with childhood histories of foster care. Many programs work with families, children or youth based on their current living situations and limits imposed by funders.

The link between homeless women's mental health and service system use.

Objective: With high rates of psychiatric and substance use problems, homeless women need a wide variety of services. This study, focusing on homeless women with and without symptoms of mental illness, examined the association of predisposing, enabling, and need factors (based on Aday-Andersen's health services utilization model) with use of behavioral, medical, and human services.

Methods: Data from 738 homeless women from the National Survey of Homeless Assistance Providers and Clients were analyzed.

Survey findings on characteristics and health status of clients treated by the federally funded (US) Health Care for the Homeless Programs.

For almost two decades, the US Health Care for the Homeless (HCH) Program has funded clinics across the country for homeless populations. Between October and December 2003, for the first time ever, a nationally representative sample of the almost 200 HCH clinics with a response rate of approximately 71% (the HCH User Visit Survey) was created to examine the health status of its users (n = 1017). This study employed the HCH User Visit Survey's cross-sectional data set to evaluate health indicators of individuals using HCH Services with the US population, and compare individuals who reported they routinely used HCH clinics ('usual' HCH users) to those who did not ('non-usual' users).

Community- versus individual-level indicators to identify pediatric health care need.

Increasingly, geographic information systems employing spatial data are being used to identify communities with poorer health care status. Since health care indicators are strongly linked to income, could these data, usually based on adult indicators, be used for pediatric health care need? We hypothesized that individual-level indicators such as quality of life scales (QOL) would be better than community-level indicators at identifying families with poorer health care practices. Surveys and medical record reviews were used for a sample of 174 caregivers of young children.

Impact of adulthood trauma on homeless mothers.

Using the National Survey of Homeless Assistance Providers and Clients (NSHAPC), we found that among homeless mothers (n = 588), those living without their children were more likely to: be older than 35 years, unmarried, have been incarcerated, have been homeless for at least 1 year, and to have used psychiatric medication. Many homeless mothers had histories of childhood trauma, but it was the accumulation of adulthood traumas that was associated with not living with one's children. Without mental health treatment, younger homeless mothers living with their children today may become the homeless mothers living without their children in the future.

Children referred for possible sexual abuse: medical findings in 2384 children.

Objective: The goal of this study was to compare rates of positive medical findings in a 5-year prospective study of 2384 children, referred for evaluation of possible sexual abuse, with two decades of research. The prospective study summarizes demographic information, clinical history, relationship of perpetrators, nature of abuse, and clinical findings. The study reports on the results by patterns of referral and the medical examination.

Essential case management services for young children in foster care.

A growing number of children in the United States are being placed into foster care. Past studies indicate that effective case manager interventions have helped foster families with a variety of different problems. This study enrolled a randomly selected sample of 130 children under age four who had been newly placed into foster care.

Foster care children and family homelessness.

Objectives: This study examined the association between family homelessness and children's placement in foster care.

Methods: The prevalence of homelessness in a random sample of 195 young foster children was examined.

Results: Almost half of the birth parents of the foster children had experienced homelessness.

The impact of outpatient drug services on abstinence among pregnant and parenting women.

Although there is an increasing number of outpatient drug programs, there remains little consensus on which service components are most effective for pregnant and parenting women seeking treatment. In this investigation, we studied 48 women who remained in treatment for 5 consecutive months to: (1) examine differences between clients who maintained 30 to 90 days of abstinence and those who did not and (2) test the association between services and abstinence. Although we found no demographic differences between abstinent and nonabstinent women, we did find that significantly more abstinent women received family therapy services compared to nonabstinent women as they remained in treatment.

The interplay of national, state, and local policy in financing care for drug-affected women and children in California.

Recent prevalence studies in California indicate that perinatal alcohol and other drug use remains a serious issue for large numbers of women and their children. In response, national, state and local policymakers have taken steps to address the problem, including increasing funding for treatment services. To gauge the impact of policy attention to this problem, the Center for the Vulnerable Child at Children's Hospital, Oakland, California, surveyed state and local administrators of programs that serve drug-affected women and children in California.

Health status of children in foster care. The experience of the Center for the Vulnerable Child.

Objectives: To describe the health status and to illustrate the usefulness of an enhanced primary care model for children in foster care.

Design: Cross-sectional analysis of a clinical cohort via chart review.

Setting: Foster Care Program of the Center for the Vulnerable Child at the Children's Hospital, Oakland, Calif.

Development of an integrated case management program for vulnerable children.

Although case management is a recognized technique to organize and coordinate human services, its use with high-risk children is relatively new. This article describes the development of a case management program for children at the Center for the Vulnerable Child at Children's Hospital, Oakland, California, a health care setting that brings together health, social work, and child welfare services. Case management was introduced into multidisciplinary clinical programs for foster children, drug-exposed infants, and adolescent mothers and their infants.

Mental health service utilization by children in foster care in California.

An examination of Medi-Cal-paid claims was undertaken to assess the utilization of mental health services by children in California's foster care system. Using unduplicate counts of service use and diagnoses, it was determined that children in foster care account for 41% of all users of mental health services even though they represent less than 4% of Medi-Cal-eligible children. When partitioned into specific service categories, children in foster care account for 53% of all psychologist visits, 47% of psychiatry visits, 43% of Short Doyle/Medi-Cal inpatient hospitalization in public hospitals, and 27% of inpatient psychiatric hospitals.

Children in foster care in California: an examination of Medicaid reimbursed health services utilization.

The number of children in foster care in California doubled from 27,534 in 1980 to more than 62,419 in 1988, representing approximately 1% of the child population in the state. Past studies have demonstrated that children in foster care have high rates of medical and mental health problems. An examination of all Medi-Cal-paid claims was undertaken to describe the utilization of health services by children in foster care.

Implementing critical health services for children in foster care.

This article reports recommendations that were developed at the California Conference on Health Care for Children in Foster Care, organized to discuss implementation in the state of CWLA's Standards for Health Care Services for Children in Out-of-Home Care. Programs and legislation developed in the state are also discussed.

Improving access to health care: case management for vulnerable children.

Health care providers are being confronted by a change in childhood morbidity from primarily physical problems to complex problems rooted in the social, family, and environmental conditions that accompany persistent urban poverty. The clustering of multiple problems in one family necessitates redefining preventive and treatment strategies. Yet the lack of coordination among federal, state and local service programs often exacerbates the vulnerability of these beleaguered children and families.

Indicators of women's alcohol problems: what women themselves report.

In-depth interviews with 65 women in treatment contributed to a taxonomy of indicators of women's alcohol problems, with five major categories and numerous subcategories. The largest number of client indicators appeared in the Individual (psychological and behavioral) category. The Physiological category included unique indicators regarding physical appearance.